At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
This role supports Quality/Patient Safety efforts for the organization. Specifically, this position is responsible for managing front line non-clinical and clinical staff related to businesses’ process supported by the department.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Excellent working knowledge of systems used for processing of QOC cases
QCare application
Microsoft applications (Outlook, Excel, Word, Teams)
Adobe Acrobat
Demographic systems (such as Facets, MACESS, UNET/COSMOS, NDB, etc.)
Auto correspondence application
Plans, prioritizes, organizes and oversees work to be completed by team staff resources to meet established objectives
Excellent verbal & written communication skills with internal & external customers.
Interface with other departments as needed (i.e. UHN, A & G, Case Management, Risk Management/Legal.)
Attend monthly Regional Peer Review Committee meetings.
Plans, prioritizes, organizes and completes work to meet established objectives.
Able to effectively utilize UHG applications related to QOC case research, including but not limited to written or verbal grievance documents, authorization applications, auto correspondence, and member & provider demographic systems.
Coordinates work activities with other supervisors and managers
Responsible for updating department Standard Operating Procedures (SOPs) and job aids
Monitor performance through multiple reports, including but not limited to the following:
Oversee supervisor preparation for Key Performance Indicator (KPI) report monthly for NVP and assist supervisor to identify root cause for outliers for TAT and fluctuations in case volume experienced.
Knowledge of state and federal regulatory requirements and applicable NCQA accreditation standards
Day Counts cases received monthly to assess for data entry errors and delayed cases.
Triage Closed Records monthly to assess for inappropriate case volume.
Triage Analyst Productivity document to assess productivity
Triage Queue monthly to assess for incoming referral volume and assure timeliness on responses
Collaborate with QOC directors for internal committee reporting
Collaborate with QOC Director to provide external regulatory reporting as required
Coordinate with Clinical Services Audit/Compliance support for submission of materials for any state or federal regulatory audits and participate in regulatory surveys as needed.
Oversee direct report management performance
Address staff performance issues through coaching and corrective action plan process as needed
Special projects as assigned by QOC director or NVP
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
Undergraduate degree or equivalent experience
Registered Nurse licensure
Quality of Care experience
Supervisory/Management experience
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.
UnitedHealth Group
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